Workplace Blues

Over 11 million people suffer from depression, but few employers offer help.

For the Boston Globe.

It’s been more than a decade, but a trace of bitterness still creeps into Karl Ackerman’s voice when he recalls his darkest days.

Not only was the Vietnam veteran coping with bipolar disorder, a condition that causes intense mood swings and depressive periods, but he found himself out of a job. Ackerman, who built computers for a small technology company, was laid off when his firm was purchased by a competitor.

“It’s a real treat trying to go to a job interview when all the typical symptoms of depression are going full bore,” the Medford resident says. “Looking for a job is hard enough, and when you’re clinically depressed it becomes an almost impossible task.”

Ackerman is far from alone. Depression affects 11 million people per year, according to Fawn Fitter, coauthor of “Working in the Dark: Keeping Your Job While Dealing With Depression.” Even so, few employers have sufficient policies in place to help sufferers. At all too many companies, the unspoken rule is “hide it,” Ackerman says. “Don’t let anybody know. Especially don’t let anybody in the company management know. Because of the rampant stigma attached to any mental illness, it can be a career killer,” he says.

Fitter concurs. She and her coauthor Beth Gulas talked to countless sufferers who had been treated unfairly because of their condition.

“Employers will discriminate against people with a psychiatric disability in ways they wouldn’t dream of discriminating against someone with a mental disability,” she says. “We talked to people who had been refused jobs, demoted, denied raises, refused promotions, held to different standards than their coworkers and even fired for no reason other than because they were depressed or had been depressed in the past.”

The difficulties depressed employees face were confirmed in a March study by researcher Dr. Thomas Carli, director of community and corporate programs at the University of Michigan Depression Center. Carli found a major divide between managers’ perceptions of depression and the reality of it as experienced by employees. Although most benefits coordinators and middle managers don’t believe depression should interfere with career advancement, the study found, only 41 percent of employees with depression believe they can get ahead in their careers if their illness becomes known.

Still, the picture has improved somewhat in the past decade. Paul Greenberg of the Boston-based Analysis Group conducted a landmark study of the costs of depression in 1990.

“Ten years ago the societal view of depression was not at all what it is now,” he says. “The notion of a psychiatric disorder being comparable to a physical disorder in how burdensome it could be was simply not on anyone’s radar screen.”

With the publicity surrounding drugs such as Prozac, depression and stress have become more widely discussed in the media. In addition, some sufferers have begun banding together in support groups such as the Manic-Depressive and Depressive Association of Boston. A February study by the American Psychological Association found that more and more Americans think health insurance should cover mental health services. Eighty-five percent now feel this way, up from 79 percent in December 2000.

The APA study also showed that a majority of Americans 54 percent are concerned about the level of stress in their everyday lives, with 1 in 5 reporting they’re “very concerned.”

Workplace stress is estimated to cost US industry $300 billion a year in terms of absenteeism, turnover, diminished productivity, and direct medical, legal and insurance fees, according to the APA.

To combat depression, stress and other psychological problems, many employers are implementing work-life balance programs, says Russ Newman, the APA’s executive director for professional practice. ” The relatively new category of work-life balance programs covers what companies do in order to recognize that employees are struggling more than ever with the responsibilities and pressures they have both at work and outside of work,” he says. “Employers put programs like flex- time in place to help employees deal with that.”

Last year the association inaugurated a recognition program, the Psychologically Healthy Workplace Awards, aimed at encouraging employers to focus more on employees’ psychological well being.

Despite such measures, there’s still a long way to go, says Ackerman. He notes that the skimpy nature of mental health coverage under most insurance plans keeps many people from getting the treatment they need.

“It’s absolutely appalling. I answer the e-mails that come into our website, and I get it all the time,” Ackerman says. “Insurance coverage pays for 10 visits, and that’s real helpful if you’re clinically depressed. A lot of insurance provides $500, and that doesn’t get you very far.”

In 2000, Greenberg did a follow-up to his 1990 study and found that employers incur $52 billion in costs because of absenteeism and the reduced productivity of depressed workers. In addition, for every two depressed employees treated, an additional three remain untreated.

Greenberg says the toll of depression is manifested in both absenteeism and a phenomenon called “presenteeism.”

“People struggle to make it into work with these symptoms and can’t attain their usual level of productivity,” he says.

Unfortunately, even as more and more specialists document the costs of depression, the options remain limited for sufferers. Different employers approach mental health problems both temporary and chronic in widely varying ways. For example, APA special projects director Luana Bossolo cites one company that took a proactive approach to the emotional toll caused by shake-ups within the organization.

“One company I saw was having layoffs, and they gave employees 120- day notice and provided outplacement services,” she says. “You’d think in an environment like that there would be stress and depression, but absenteeism did not increase, even among employees that were being downsized. A lot of employees even expressed gratitude for the way the company handled it.”

But different types of depression require different coping methods. Fitter says the best approach will vary according to any number of circumstances, from the size of the employer to the nature of the depression. Sufferers are protected from discrimination under the Americans With Disabilities Act, so it is possible to ask for accommodations under its provisions. But employees must understand exactly how the law applies to them.

As a first step, Gulas recommends seeking help from a psychiatrist or therapist who has experience dealing with workplace depression.

Ask potential therapists if they’re familiar with the ADA, if they’ve ever helped patients cope with depression in the workplace, and what solutions they commonly recommend.